Modulation of mTORC1 and IL-6 Following Mirror Therapy and Pregabalin in Complex Regional Pain Syndrome Type 1

Abstract

Aim: The study was designed to evaluate the modulation of mTOR complex 1 (mTORC1) and IL-6 genes following the use of mirror therapy (MT) and pregabalin in complex regional pain syndrome type-1 patients. Materials & methods: Two groups of 20 patients: MT group received MT and pregabalin, control therapy group received pregabalin. Neuropathic pain symptom inventory (NPSI), numeric rating scale – pain, modified motor activity log, SF-12 questionnaire for quality of life and IL-6 and mTORC1 expression were evaluated. Results: Group MT demonstrated a statistically significant improvement in NPSI burning, NPSI allodynia and numeric rating scale pain scores, modified motor activity log and SF-12 scores. Significant downregulation of mTORC1 and IL-6 observed in both. Conclusion: MT is a significant adjunct to pregabalin in improving motor function, quality of life and alleviating pain in complex regional pain syndrome type 1.

Clinical Trial Registration: CTRI/2019/01/017272 (ClinicalTrials.gov)

Plain language summary

Complex regional pain syndrome is a form of long-term pain that involves an arm or a leg. It can develop after an injury, a surgery or a stroke. Although many drugs have been used for its treatment, the limited relief that these drugs produce along with their side effects have shifted focus to other physical and psychological modes of therapy. Mirror therapy is one such modality where the image of normal functioning limb seen in a mirror placed over the affected limb leads to pain relief in the affected limb. We have provided evidence that mirror therapy can reduce the pain of this syndrome and also decrease the levels of pain related genes in the body. This will help us to devise better treatment strategies for complex regional pain syndrome.

Keywords::

• CRPS type1
• IL-6
• mirror therapy
• motor activity
• mRNA expression
• mTORC1
• pregabalin

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/pmt-2022-0020

Author contributions

AK Saxena suggested the research topic and supervised the research work. A Malik performed the research work as a part of his Post Graduation M.D. thesis, was the primary investigator. A Singh, GT Chilkoti, M Bajaj supervised the research work. N Bhardwaj helped the primary investigator in carrying out the genetic analysis. BD Banerjee: He is the head of the Department of Environmental Biochemistry and Molecular Biology, University College of Medical Sciences & G.T.B. Hospital where the genetic analysis was carried out. R-ul-Haq: He is a professor of Department of orthopedics, University College of Medical Sciences & G.T.B. Hospital. CRPS type 1 were referred from the Department of orthopedics to the pain clinic with his due permission.

Acknowledgments

Our soulful gratitude to all the participants in this study who have extended their full cooperation. Our special thanks to various resident doctors of the Department of Orthopedics and Research Associates of the Department of Molecular Biology.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Data sharing statement

The authors certify that this manuscript reports original clinical trial data. Deidentified, individual data that underlie the results reported in this article (text, tables, figures and appendices), along with the study protocol will be available up to 3 years from the date the of acceptance.